Advocates fear patient care will suffer under state budget cuts

Gov. Jerry Brown announced a state budget yesterday that relies on hospitals and nursing homes to achieve nearly $400 million in savings - a week after a far smaller proposal prompted concerns about patient care.

The governor's revised budget is the starting point to closing a $15.7 billion deficit. He proposed making further cuts to human services, paring down hours of care provided to In-Home Supportive Services recipients, and limiting child care support provided by the CalWORKs program.

The revised budget poses a new set of challenges to care providers and patient advocates. Last week, groups representing doctors, nurses and nursing home residents decried a comparatively minor budget change that would have cut the mandate for hospital and nursing home inspectors to perform unannounced inspections to monitor compliance with state laws.

The
budget proposal
by the state Health and Human Services Agency would have eliminated 25 nurse-inspector positions and slashed fees paid by hospitals and nursing homes that go toward enforcing patient safety laws.

Health and Human Services Agency Director Diana Dooley said that the proposal to change facility inspections was unrelated to yesterday's budget cuts. Rather, it was meant to streamline state operations "where we believed we could assure quality and safety in care," Dooley said.

While both Senate and Assembly budget subcommittees voted down the proposal last week, advocates say they are wary that it may arise again. Ken August, a spokesman for the Department of Public Health, which inspects care facilities, said no decision had been made as to whether the proposed change might resurface.

Under the proposal, inspections for compliance with federal patient safety safeguards would still take place. But advocates opposing the proposal point to a raft of California-only provisions that are meant to protect patients young and old.

The California Medical Association, which represents about 30,000 doctors, wrote a letter in opposition, listing some protections that might be curtailed if inspectors stop checking.

The protections include requirements that emergency medications in neonatal intensive care units are appropriate for babies. They encompass informed-consent rights for patients undergoing a sterilization or hysterectomy. And they require that inspectors verify that reports are made to the state Medical Board about potentially errant or negligent doctors.

The budget proposal would have also removed the requirement that hospitals be inspected by a licensed doctor, nurse and "persons experienced in hospital administration and sanitary inspections."

The medical board also opposed that proposal, saying in an era of major changes due to budget cuts and health reform, "the need to continue to ensure facilities' compliance with vital state laws has never been greater."

State hospital and nursing home inspectors fine facilities for some violations. For others, they cite deficiencies and follow-up with administrators on corrective actions.

The California Hospital Association has not taken a position on the proposal, said spokeswoman Jan Emerson Shea.

Representatives of the United Nurses Association of California and Disability Rights California opposed the agency's budget change. Also, advocates for nursing home patients spoke out during last week's hearing.